Migration of the femur head in rheumatoid coxitis.

The direction of penetration of the destroyed femoral head into the acetabulum in rheumatoid coxitis has been determined by means of the method of geometrical analysis in 81 affected hip joints. Of 48 patients, the duration of coxitis was 1-17 years (mean 4 years). Displacement of the femur head, destroyed by rheumatoid inflammation, was expressed in millimeters by means of a geometrical parameter called "transposition of the center of the femur head". The direction of transposition of the femur head into the deepened acetabulum has been expressed quantitatively by authors making use of the new geometrical parameter "the angle of transposition of the center of the femur head" which is referred to as angle delta. The angle delta is an angle between the line of transposition of the femur head center (tC) and its vertical component. The mean value of the delta angle for the entire group investigated measured 27.6 degrees and ranged from -5 degrees to +54 degrees, whereby an angle of 0 degrees marked the cranial direction of transposition, positive values marked the craniomedial transposition direction of the femur head. The angle delta varied from 21 degrees to 40 degrees in the majority of affected hip joints. The values of the delta angle were constant in every hip joint, thus indicating that the direction of transposition of the femur head did not change in the course of the progression of rheumatoid coxitis. It was found and statistically confirmed that no reciprocal dependence existed between the rate of progression of coxitis and the direction of displacement of the femur head into the acetabulum.(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind trial of ademetionine vs naproxen in activated gonarthrosis.

The efficacy and safety of ademetionine (A) vs naproxen (N) were tested in a double-blind trial carried out in 20 patients, each with activated gonarthrosis. The trial lasted 6 weeks. During the first week, A was administered at a daily dose of 3 x 400 mg and afterwards at a dose of 2 x 400 mg, whereas the daily dose of N during the first week was 3 x 250 mg and subsequently 2 x 250 mg. During the first two weeks, the patients were allowed to take paracetamol as an additional analgesic. The patients were examined at the beginning of the study and after 2, 4 and 6 weeks. The parameters tested were: pain (under different conditions), crepitation, joint swelling, circumference of joint, extent of motility and walking time over 10 meters. In addition to the usual laboratory tests, the serum keratane-sulphate concentrations (with monoclonal antibodies according to the ELISA technique of Eugene et al. [1985]) were also determined. At the end of the 6th week no statistically significant difference between the two patient groups treated was found; both groups exhibited a marked improvement on all parameters. At the end of medication, the keratane-sulphate concentrations were not significantly changed. Five patients under A and 3 under N reported gastrointestinal side effects which were possibly drug-related. This study, performed in a small number of patients, showed a good efficacy and safety of ademetionine. Only further studies on a larger scale will show the importance of ademetionine in the therapy of rheumatic diseases.

Prognosis of rheumatoid coxitis.

Geometrical analyses of the anteroposterior X-rays of 81 hips affected by rheumatoid arthritis for 1 to 17 years, have shown that the rate of progression of the inflammatory destructive lesions in the hip, expressed quantitatively in millimeters per year, depends on the local anatomical relations in the coxofemoral joint itself. This relationship is expressed by the angle of penetration of the plane of the acetabular opening (PEC) (angle PEC = angle CCD + angle n - angle PE). The PEC angle was found to be within the range of 85 to 128 degrees, and its mean value for the whole group was 104.6 degrees. In hips affected by rheumatoid arthritis for the same period of time, the average rate of progression of coxitis was twice as high when the PEC angle was up to 104 degrees than when it was 105 or more degrees. This difference is statistically significant. Irrespective of the magnitude of the angle of penetration through the plane of the acetabular opening (PEC), coxitis was found to progress the most rapidly during the first years of hip affection, and to diminish thereafter along a parabolic curve. The knowledge gained in this study makes it possible to predict the rate of progression of coxitis and is a contribution to a better clinical and radiological understanding of rheumatoid arthritis of the hip joint.

[Determination of early changes in the rheumatoid hand with an electronic color analyser]. / Bestimmung von Frühveränderungen an der rheumatoiden Hand mit einem elektronischen Farb-Analysator.

Using soft rays, X-ray pictures were taken of the hands of patients with possible and probable rheumatoid arthritis, and were then subjected to electronic colour analysis. This method represents a contribution to early diagnosis of rheumatoid arthritis, makes the distinction between the joint capsule and rheumatoid pannus possible, and ensures the early discovery of cartilage damage, which has not been possible with any other noninvasive method.

[Pustular arthro-osteitis. A new entity among rheumatic diseases?]. / Pustulöse Arthroosteitis. Eine neue Entität unter den rheumatischen Krankheiten?

A patient is shown with symptoms of the anterior thoracic wall syndrome and pustulous changes on the palms an soles. In the clinical picture, a painful swelling of the medial third of the right clavicle dominated, while the general state of the patient was good. Laboratory findings showed positive tests of inflammatory activity, while the rheumatoid factors and the HLA B 27 antigen were negative. Radiologically wide-spread destructive changes of the medial part of the right clavicle were found, with signs of periostosis in the active phase of the disease and osteosclerosis in remission. The symptoms of the anterior thoracic wall have often relapsed, while the plamo-plantar pustulosis was present only at the onset of the disease. The function of locomotor system remained undamaged even after eight years of the disease duration. The disease was, after its clinical, laboratory and radiological aspect, different from all up to now known rheumatic diseases as well as from other diseases with symptoms on the locomotor system. It fits into the syndrome which was described by japanese authors under the name of "pustulous arthroosteitis".

Diclofenac sodium (Voltaren): results of a multi-centre comparative trial in adult-onset rheumatoid arthritis.

A short-term trial has been performed under double-blind conditions in 50 adult patients with rheumatoid arthritis to compare diclofenac sodium (Voltaren) with both indomethacin and placebo for efficacy and tolerability. The duration of the trial was two weeks and was a between-patient comparison of 25 mg t.i.d. diclofenac sodium, 25 mg t.i.d. indomethacin or placebo using a double-dummy technique. Forty-eight patients completed the trial. In the majority of parameters examined, diclofenac sodium was superior to placebo and indomethacin in therapeutic effect. One patient was withdrawn from the trial because of intolerance to indomethacin and one other because of severe joint pain under indomethacin therapy. Neither active compound caused clinically significant changes in blood picture or urine analysis.